Long-Term Outcomes Following Inguinal Hernia Repair With Mesh Performed by Medical Doctors and Surgeons in Ghana

Jessica H. Beard, Michael Ohene-Yeboah, E. S. Kasu, Nelson Affram, S. Tabiri, J. Amoako, F. Abantanga, J. Löfgren
{"title":"Long-Term Outcomes Following Inguinal Hernia Repair With Mesh Performed by Medical Doctors and Surgeons in Ghana","authors":"Jessica H. Beard, Michael Ohene-Yeboah, E. S. Kasu, Nelson Affram, S. Tabiri, J. Amoako, F. Abantanga, J. Löfgren","doi":"10.1097/as9.0000000000000460","DOIUrl":null,"url":null,"abstract":"\n \n To assess long-term outcomes following inguinal hernia repair with mesh performed by medical doctors and surgeons in Ghana.\n \n \n \n Task sharing of surgical care with nonsurgeons can increase access to essential surgery. Long-term safety and outcomes of task sharing are not well-described for hernia repair.\n \n \n \n This prospective cohort study was conducted in Ho, Ghana. After completing a training course, 3 medical doctors and 2 surgeons performed inguinal hernia repairs with mesh on men with primary, reducible hernias. The primary outcome of this study was hernia recurrence at 5 years. The noninferiority limit was 5 percentage points. Secondary endpoints included pain and self-assessed health status at 5 years.\n \n \n \n A total of 242 operations in 241 participants were included, including 119 hernia repairs performed by the medical doctors and 123 performed by the surgeons. One hundred and sixty-nine participants (70.1%) were seen in follow-up at 5 years, 29 participants (12.0%) had died and 43 (17.8%) were lost to follow-up. The overall 5-year recurrence rate was 4.7% (n = 8). The absolute difference in recurrence rate between the medical doctor group (2 [2.3%]) and the surgeon group (6 [7.3%]) was −5.0 (1-tailed 95% confidence interval, −10.5; P = 0.06), demonstrating noninferiority of the medical doctors. Participants experienced improvements in groin pain and self-assessed health status that persisted at 5 years.\n \n \n \n Long-term outcomes of elective mesh inguinal hernia repair in men performed by medical doctors and surgeons in Ghana were excellent. Task sharing is a critical tool to address the substantial morbidity of unmet hernia surgery needs in Ghana.\n","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Surgery Open","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/as9.0000000000000460","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

To assess long-term outcomes following inguinal hernia repair with mesh performed by medical doctors and surgeons in Ghana. Task sharing of surgical care with nonsurgeons can increase access to essential surgery. Long-term safety and outcomes of task sharing are not well-described for hernia repair. This prospective cohort study was conducted in Ho, Ghana. After completing a training course, 3 medical doctors and 2 surgeons performed inguinal hernia repairs with mesh on men with primary, reducible hernias. The primary outcome of this study was hernia recurrence at 5 years. The noninferiority limit was 5 percentage points. Secondary endpoints included pain and self-assessed health status at 5 years. A total of 242 operations in 241 participants were included, including 119 hernia repairs performed by the medical doctors and 123 performed by the surgeons. One hundred and sixty-nine participants (70.1%) were seen in follow-up at 5 years, 29 participants (12.0%) had died and 43 (17.8%) were lost to follow-up. The overall 5-year recurrence rate was 4.7% (n = 8). The absolute difference in recurrence rate between the medical doctor group (2 [2.3%]) and the surgeon group (6 [7.3%]) was −5.0 (1-tailed 95% confidence interval, −10.5; P = 0.06), demonstrating noninferiority of the medical doctors. Participants experienced improvements in groin pain and self-assessed health status that persisted at 5 years. Long-term outcomes of elective mesh inguinal hernia repair in men performed by medical doctors and surgeons in Ghana were excellent. Task sharing is a critical tool to address the substantial morbidity of unmet hernia surgery needs in Ghana.
加纳内科医生和外科医生使用网片进行腹股沟疝修补术后的长期疗效
评估加纳内科医生和外科医生使用网片进行腹股沟疝修补术后的长期疗效。 与非外科医生分担手术护理任务可以提高基本手术的可及性。对于疝气修补术来说,任务分担的长期安全性和效果还没有很好的描述。 这项前瞻性队列研究在加纳胡市进行。在完成培训课程后,3 名内科医生和 2 名外科医生对患有原发性可复性疝气的男性进行了腹股沟疝修补术。这项研究的主要结果是 5 年后疝气复发。非劣效限为 5 个百分点。次要终点包括 5 年后的疼痛和自我评估的健康状况。 共有241名参与者接受了242次手术,其中119次由内科医生进行疝气修补,123次由外科医生进行。169名参与者(70.1%)在5年后接受了随访,29名参与者(12.0%)死亡,43名参与者(17.8%)失去了随访机会。5年总复发率为4.7%(n = 8)。内科医生组(2 [2.3%])与外科医生组(6 [7.3%])之间复发率的绝对差异为-5.0(1-tailed 95% 置信区间,-10.5;P = 0.06),这表明内科医生的治疗效果并不差。参与者的腹股沟疼痛和自我评估的健康状况均有所改善,这种改善持续了 5 年。 在加纳,由内科医生和外科医生对男性进行选择性腹股沟网状疝修补术的长期疗效非常好。任务分担是解决加纳疝气手术需求得不到满足而导致大量发病的关键手段。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信